Made available in DSpace on 2014-06-11T19:26:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-29Bitstream added on 2014-06-13T18:06:38Z : No. of bitstreams: 1 paveloski_em_me_bauru.pdf: 828753 bytes, checksum: b443cc0b09bd4dc5570267c14288216d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este trabalho aborda como tema principal a situação da geração, segregação e disposição final dos Resíduos de Serviços de Saúde na região do Coder (Conselho de Desenvolvimento Econômico Regional) que tem como sede o município Bauru. O objetivo foi levantar dados, avaliar a situação atual da questão dos RSS e propor soluções para uma melhor gestão deste tipo específico de lixo urbano. Ao cumprir tais objetivos, as considerações expostas pelo autor levam a um retrato da situação atual dos resíduos de serviços de saúde na região, trazendo também um panorama do tema no Brasil e no Estado de São Paulo, expondo as fragilidades das leis que contemplam mais os grandes geradores e a baixa qualificação da mão de obra, o que diminui o processo de segregação e, no destino final, problemas ambientais. / The theme of this work is about generation, segregation and final disposal of Health Services Residues (RSS) in the region of CODER (Regional Economic Developing Council), which is based in Bauru. The aims of this research are to improve the management of this specific type of urban waste. In order to accomplish such objectives, considerations made by the author of this dissertation show a portrait of the actual situation of the RSS in the region researched and a panorama of the theme in Brazil and in São Paulo state. It possible to observe in this work the weaknesses of the laws that serve mostly big generators of waste and the low qualified work force, which diminishes the quality of segregation process and environment problems during the final disposal of the waste.

O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

M.Cur. / Following the democratic elections that took place in 1994, South Africa is undergoing transformation. This transformation was initiated by the external and internal driving forces, of which, the political forces are the most significant. This political transformation led to the promulgation of the Constitution of the country, which impacted on the transformation of the health system, to ensure accessibility and equity. The promulgation of the Constitution was followed by many legislative and policy changes, such as a new Higher Education Act. The South African transition from apartheid to democracy, necessitated that all the existing policies, institutions and practices should be transformed and revised, according to the demands of the new era. With the new political dispensation of the country, many regional, national and local policies have changed. These changes have had an inevitable impact on higher education, which in turn impacts on nursing education. The change in the higher education system required the restructuring and rationalisation of nursing colleges in all the provinces. The need for the transformation of nursing colleges is unavoidable because of the development of the new legislation to readdress the imbalances of the past. Following the new political dispensation, it was however necessary to transform these nursing colleges through rationalisation/integration. The focus of this study is on the transformation of nursing colleges in Gauteng, which poses many challenges to the directors in terms of the management of transformation. The transformation process impacts directly on the directors of nursing colleges. This study is based on the transformation management of selected nursing colleges in Gauteng. The study is conducted in two phases. Phase one explores and describes the experiences and perceptions of directors regarding the transformation of nursing colleges in Gauteng. Phase two describes the formulation of transformation management standards which consists of two phases of standards formulation, namely, the development phase and the quantifying phase.

All organisations compete on the basis of service. In today‘s highly competitive world, organisations need to compete to retain their customers and to offer good customer service that will give them a competitive advantage. In the South African pharmaceutical market, the introduction of the Single Exit Price (SEP) and generic substitution have led to the price of equivalent medicines no longer being the differentiating factor in a customer deciding which manufacturer‘s product to purchase. The availability of generic medicines at the pharmacy or hospital has become the differentiating factor. Two types of customers exist in any organisation, namely, external customers and internal customers. Much has been written about the external customer, but less about the internal customer. Many managers do not perceive internal customer service as a priority. Any organisation attempting to deliver quality service to their external customers must begin by serving the needs of their internal customers. Internal service quality is characterised by the attitudes that people have towards one another and in the way that employees serve one another inside the organisation. By improving customer service, the organisation can improve its profitability, sustainability and customer retention. The aim of this study was to determine whether the levels of internal customer service between the three sections of Aspen Pharmacare are optimal. Determining the current performance levels between the staff of the sections will assist in highlighting the areas that require attention. The three sections of Aspen Pharmacare that are internal customers of one another and have been used in the study are: - production; - demand planning; and - distribution. The results of the study show that all three sections rate three service quality dimensions (communication, tangibles and reliability) as important. The results were used to develop an internal customer service model for Aspen Pharmacare.

The search for service and product quality has come to the forefront of business studies as the most important consumer trend of the past two decades. Studies conducted indicate that the 1990s saw a dramatic change in customer expectations concerning service quality and standards with a corresponding increase in the number of complaints from disgruntled customers. In response to this, many organisations have established customer care and complaints management services to respond to the need of customers. A substantial amount of literature exists on the subject of complaints management and its role in service quality, however, the focus has been on organisations in the private sector. The research undertaken in this paper aimed to investigate the role of complaints management systems (CMS) to evaluate service quality. The focus of this research was on local government with special attention on George Municipality. A literature review was done to establish the importance of service quality for local government as well as to investigate the link between an effective complaints management system and improvement in service quality. Furthermore, it was necessary to investigate the characteristics, design and implementation of an effective complaints management system. A questionnaire was developed in order to obtain primary data from a selected sample group. The data obtained from the questionnaire was statistically analysed and interpreted. The core findings from the analysed questionnaire indicated the following:  service quality is relevant in local government;  there is no clear method to measure service quality;  no formal and structured complaints management system exist, and  the implementation of an effective complaints management system will both improve service delivery and provide benefits to all involved. iv This study recommends that:  service quality standards and measurement be of strategic importance to local government;  customers should be consulted and involved when determining the service quality standards and measurement, and  an organised and structured complaints management system that seeks to address all complaints in order to improve the level of service quality to customers be developed. Finally, the success of the CMS will depend on management’s commitment to change on a continuous basis as well as the degree to which management proactively resolves customer complaint through the involvement of the customer.

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Thesis (MPH.) -- University of Limpopo, 2015 / Nurses are an integral component of the health care delivery system and they encounter occupational health problems classified as biological, chemical, physical, and psychosocial hazards. Nurses also face health hazards such as Hepatitis B, Acquired Immune Deficiency Syndrome, tuberculosis, cytotoxic drugs, anesthetic agents, needle stick injury, back pain, and stress. At Letsholathebe II Memorial Hospital in Maun, nurses and other health professionals face occupational health and safety risks at the workplace. Aim and Objectives The aim of the study was to identify the occupational health hazards encountered by nurses at Letsholathebe II Memorial Hospital in Maun, Botswana. The objectives were to identify occupational health hazards at Letsholathebe II Memorial Hospital; determine organic and inorganic disorders caused by occupational health hazards; determine coping mechanisms of nurses towards occupational health hazards and the compliance of nurses to written protocols that address occupational health hazards. Research Method and Design A quantitative descriptive cross-sectional method was adopted. The population comprised 200 nurses employed at Letsholathebe II Memorial Hospital. Simple random sampling was used to select 132 nurses who participated in the study. A self-administered questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis. Results The study revealed health hazards namely; back aches, frequent headaches, and persistent tiredness; mercury, solvents and anaesthetic gases; HIV, streptococcus, staphylococcus, Hepatitis B and measles. Nurses also reported fatigue, loss of sleep due to stress, anxiety and persistent tiredness. Conclusion The study concluded that nurses at Letsholathebe ll Memorial hospital experienced physical, chemical, biological and psychological health hazards. Recommendations The study recommends that nurses should have access to OHS information, that OHS awareness should be created at Letsholathebe II Memorial Hospital.

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No description available.

Objectives: Women with substance use disorders often experience unique challenges to obtaining contraception and adhering to user-dependent methods. As a result, this at-risk population of women tends to have higher than average rates of unintended pregnancy. The objective of this study was to describe contraceptive use, pregnancy intentions, and adequacy of access to reproductive healthcare among women receiving opioid agonist therapy in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. Descriptive analyses were conducted using logistic regression to evaluate the statistical significance of bivariate associations. Results: Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to health care. More than half had a history of unwanted pregnancy (53%), among whom few (23.1%) reported the consistent use of contraception at time of conception. Although most desired to avoid pregnancy (90%), only 59% of women reported the current use of regular contraception. Most of those not using regular contraception believed that they were not at risk for pregnancy (54.3%). Conclusions: Although most participants reported adequate access to health care and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Research is needed to identify barriers to contraceptive acceptance and causes of pregnancy risk misperceptions in this population of women at increased risk of unintended pregnancy.